Treatment for rheumatoid arthritis

In fact, there are treatments that allow controlling the disease in a significant percentage of people. It is important to note that collaboration between the doctor and the patient is essential for the control of rheumatoid arthritis. Pain in small and large joints is the first symptom of rheumatoid arthritis. The onset is gradual or insidious, with progression of symptoms and addition of new joints; the course is chronic. Pain is a consequence of joint inflammation, which is often seen with the naked eye in people with rheumatoid arthritis. The joints most commonly damaged are the wrists, the knuckles, the joints of the fingers, where it is noteworthy that it does not usually affect the distal interphalangeal joints (joint closest to the end of the fingers), shoulders, elbows, hips, knees, ankles and toes, followed by hip and temporomandibular joints. Neck pain can also be caused by rheumatoid arthritis and, therefore, should be evaluated by the doctor.

Although it can not be prevented, following some recommendations can relieve the symptoms of rheumatoid arthritis.

• A hectic life with great physical activity or psychic stress should be avoided as much as possible. It is advisable to sleep an average of 8-10 night hours. It is good to start the day with a good bath of hot water that will help to reduce stiffness or joint stiffness in the morning.
• Regarding work, if possible, avoid activities that require physical effort, force them to stand for a long time, or need repetitive movements, especially with their hands.
• In domestic work, you should avoid using your hands, such as opening lids, twisting clothes, pressing mops, etc. In some orthopedics are useful tools for household chores.
• If you want to play sports, it is convenient to ride a bike on the flat, swim or walk.
• During the rest it is important to maintain a proper posture, the joints should not remain bent, we must try to have arms and legs stretched. It is advisable to put a table under the mattress and use a low pillow.
• Obesity is obviously an additional burden on the joints of hips, knees and feet, so it is advisable to avoid overweight.
• As for the care of the joints, an inflamed joint must be kept at rest, the overuse of it can favor irreversible damage to the bones that form the joint.
• Once the inflammation has passed, exercises that preserve movement can be performed. However, even during joint inflammation, it is very convenient to maintain good musculature around the inflamed joint, but without moving the joint. It is useful to learn to contract the muscles located around a certain inflamed area. This can be done so-called “isometric” exercises, which serve to strengthen muscles and bones.
• Maintain muscle contractions lasting 20 seconds, 10 times a day, providing an adequate muscle tone. The use of devices that maintain the correct position of the fingers of the hands (splints) during the night, although initially uncomfortable, prevents future deformities.
• Infections in patients with rheumatoid arthritis should be prevented. Among other measures, it is advisable to apply the usual vaccines, never with attenuated microorganisms if you are in immunosuppressive treatment, avoid contact with tuberculous patients, and do prophylaxis with isoniazid when appropriate, as well as maintain a scrupulous dental hygiene.
• It is advisable to eliminate tobacco consumption for all patients with rheumatoid arthritis.
• The Spanish Society of Rheumatology offers patients a Guide to learn to live with rheumatoid arthritis, with useful advice, resources and care for day to day.
• A multidisciplinary approach is required for the treatment of rheumatoid arthritis; a constant relationship between physiotherapists, occupational therapists, chiropodists, social services and surgeons is needed to keep abreast of patient progress and new therapeutic developments.

The medications used for rheumatoid arthritis have side effects, therefore, any treatment to be applied implies the need to consider that the benefit is greater than the risk.

In addition, the variable nature of the disease requires readjusting the treatment in the same patient. In the end it will be the patient who will decide if he assumes the treatment after having all the possible information. The joints most commonly damaged are the wrists, the knuckles, the joints of the fingers, where it is noteworthy that it does not usually affect the distal interphalangeal joints (joint closest to the end of the fingers), shoulders, elbows, hips, knees, ankles and toes, followed by hip and temporomandibular joints. Neck pain can also be caused by rheumatoid arthritis and, therefore, should be evaluated by the doctor.

The treatment of rheumatoid arthritis can be classified into several groups:

• A group includes drugs that are responsible for relieving pain and inflammation in the short term; these are useful to reduce inflammation and cope with the pain of “day to day”, but do not intervene in the evolution of the disease in the long term. This group includes anti-inflammatories and corticosteroids.
• Another large group includes drugs that do not work for pain at a certain time; if not, they act by making the activity of the disease lesser in the long term, that is, they delay the progression of the disease. These are the so-called disease-modifying drugs (DMARDs); these drugs may not be effective in 100% of patients, and this means that the doctor has to prescribe several sequentially until finding the one that is more effective and better tolerated. Keep in mind that they are slow-acting drugs and take weeks, and even months, to take effect. The most representative of this group are Methotrexate and Leflunomide, being very effective and fast in their performance. Others such as gold salts, chloroquine, sulfasalazine, cyclosporine.

The deformity of the fingers frequently referred to as in “swan neck” and in “eyelet” occurs late in the course of rheumatoid arthritis, and is characteristic of chronic disease; it is usually not seen in the initial presentation, where the signs of synovitis and joint damage are subtle.

There are also other associated extra-articular symptoms, which are alterations of the disease at other levels, these are:

• Thinning.
• Asthenia or fatigue.
• Unexplained fever.
• Xerostomia, that is, dry mouth.
• Xerophthalmia or dry eyes, sand and red eyes.
• Lumps in the skin called subcutaneous nodules, which are characteristic of rheumatoid arthritis, although they are not exclusive to it, since they sometimes appear in other diseases.
• Muscular weakness.
• Severe and persistent neck pain.
• Tingling in hands or feet.
• Hoarseness maintained without noticing a cold.

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